<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        <div class="layui-row">
            <div class="layui-col-xs6">
                <div class="layui-form-item">
                    <label class="layui-form-label">姓名</label>
                    <div class="layui-input-block">
                        <input type="text" name="name" lay-verify="required" class="layui-input" placeholder="请输入姓名" value="{$row.name|default=''}">
                    </div>
                </div>
                <div class="layui-form-item">
                    <label class="layui-form-label">手机号</label>
                    <div class="layui-input-block">
                        <input type="text" name="mobile" class="layui-input" lay-verify="required|phone" placeholder="请输入手机号" value="{$row.mobile|default=''}">
                    </div>
                </div>
                <div class="layui-form-item">
                    <label class="layui-form-label">接种剂次</label>
                    <div class="layui-input-block">
                        <select name="dosage">
                            <option value=''></option>
                            {foreach $getDosageList as $k=>$v}
                            <option value='{$k}' {in name="k" value="$row.dosage"}selected=""{/in}>{$v}</option>
                            {/foreach}
                        </select>
                    </div>
                </div>
            </div>
            <div class="layui-col-xs6">
                <div class="layui-form-item">
                    <label class="layui-form-label">身份证号</label>
                    <div class="layui-input-block">
                        <input type="text" name="id_card" class="layui-input" lay-verify="required|identity" placeholder="请输入身份证号" value="{$row.id_card|default=''}">
                    </div>
                </div>
                <div class="layui-form-item">
                    <label class="layui-form-label">接种时间</label>
                    <div class="layui-input-block">
                        <input type="text" name="vaccination_time" data-date="" data-date-type="datetime" class="layui-input" lay-verify="required"  placeholder="请输入接种时间" value="{$row.vaccination_time|default=''}">
                    </div>
                </div>
                {if $isSuper}
                <div class="layui-form-item">
                    <label class="layui-form-label">居住地所属社区</label>
                    <div class="layui-input-block">
                        <select name="community">
                            {foreach $getCommunityList as $k=>$v}
                            <option value="{$v.id}" {in name="v.id" value="$row.community"} selected{/in}>{$v.name}</option>
                            {/foreach}
                        </select>
                    </div>
                </div>
                {/if}
            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">现居住地址</label>
            <div class="layui-input-block">
                <textarea name="living" class="layui-textarea" lay-verify="required" placeholder="请输入现居住地址">{$row.living|raw|default=''}</textarea>
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>
    </form>
</div>